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Module 2: Patient Barriers to Care

“Although most working age adults with refractive error in Britain are undiagnosed, a large number are aware of having less than "normal" vision but, rather than seeking "treatment", may be adapting their lives, including possibly limiting participation in certain activities in the interests of safety, to avoid adverse functional outcomes.”(1)

Patient barriers to care are one of the most difficult obstacles to overcome in the goal to ensure quality care to the community.  As the study quoted above indicates, many people do not seek (or cannot arrange) medical attention due to those barriers, and instead are forced to alter their lives because of the condition that they have.  Those committed to improving health have the responsibility to recognize these barriers and work to reduce barriers to care and ensure that all have access to quality medical care.

Barriers to Care

1. Cost: A study conducted in Australia found that 86% of those who needed eye surgery made the equivalent of $20,000 or less per year.(2)  Other studies suggest that in the US and the UK, low socioeconomic status has been shown to correlate with a lack of access to care, as well as a higher likelihood of eye problems.(3)
2. Lack of Education and Awareness: “Less educated individuals have increased difficulty navigating within the healthcare system, and perhaps the current public health messages are not fully comprehended by them,” suggest Varma and colleagues.  Furthermore, a lack of awareness can lead to people not recognizing their eye problems as an important issue requiring attention.  For example, Varma et. al.’s research found that many people did not seek care because they believed that poor vision is part of the aging process and is not treatable through medical means.(4)
3. Fear: For many people who have never sought the attention of an eye doctor or other medical specialist, the idea of seeing a doctor can induce fear, especially if they have misconceptions about the field or practices due to a lack of awareness or experience.
4. Language: The language barrier contributes greatly to the lack of access to proper healthcare, especially in the Hispanic population of the United States.(5)  Further studies conducted in Australia reveal that lack of command of the English language was the second most important predictor (behind lack of medical insurance) in determining whether or not a person obtains cataract surgery.(6)

Many of these barriers to care affect and reinforce one another.  For example, being an ethnic minority in the US such as Hispanic may entail lower socioecnomic status (which makes cost a barrier), lack of full English communication skills, a lack of education or awareness about eye problems (due to a lack of English skills), and perhaps fear of the medical establishment because of that lack of awareness.  These barriers are very hard to overcome, and community health groups should work with individuals to eliminate these barriers to care.

Go To Module 3: Reducing Patient Barriers to Care >>

Footnotes

Evidence-Based Community Eye Health Online Course

• Table of Contents
• Module 1
• Module 2
• Module 3
• Module 4
• Module 5
• Module 6